The pace of scientific research in the global development of new cancer treatments is astonishing, with precision medicines dramatically improving survivability rates; these have doubled since 1970. Immuno-oncology therapies empower the immune system to recognise and react to tumour cells, and biomarkerguided therapies target the mutation in tumour cells at a molecular level, in effect creating a completely personalised approach to treatment, treating the disease at a systemic level.
In parallel with the developments in clinical treatment, new cancer care environments are enabling patients to be treated in increasingly personalised environments, or even in the comfort of their own homes, if their circumstances allow this. Individual flexible chemotherapy bays incorporated into departmental layouts allow patients to control their own environment, and choose a level of interaction with others that suits them. This sense of control over environment and choice extends to the design of waiting areas and provision of external spaces adjacent to treatment areas. Production pharmacies co-located on hospital sites allow individualised medicines to be created locally to the patient, taking place side by side with biological research and clinical trials.
The power of personalised treatments
We will cover the power of personalised treatment healing and research, grounded by three recent BDP case study projects – the new Clatterbridge Cancer Centre in Liverpool, the replacement for the Paterson Research Building at the Christie Hospital in Manchester, and The Oak Cancer Centre in South London.
Clatterbridge Cancer Centre, Liverpool
Completed in 2020, with an overall area of 27,800 m2 , Clatterbridge Cancer Centre is located within the heart of the city’s Knowledge Quarter on a site adjacent to the Royal Liverpool University Hospital, and close to the University of Liverpool. Having previously been based on the Wirral, with a dedicated radiotherapy centre at Aintree University Hospital, the location next to an acute hospital (Royal Liverpool University Hospital) enables both pioneering clinical trials and care for more complex and seriously unwell cancer patients, with rapid access to critical care and acute medical and surgical specialties.
The specialist 11-storey hospital has 110 single inpatient beds, delivering a wide range of highly specialist cancer care, including pioneering chemotherapy, immunotherapy, gene therapy, haematooncology, and radiotherapy. It has state-of-the-art facilities for bone marrow transplant, diagnostics, and imaging, outpatients, day case treatments, a Teenage & Young Adult Unit, and clinical therapies.
Privacy and space
The hospital has also been designed to ensure that patients have plenty of privacy and space, which can be personalised to individual needs. Every inpatient has their own single en-suite room, further reducing any risk of infection. The inpatient rooms and the Chemotherapy suite benefit from being at the top of the building, and have spectacular views across the city and across to the Wirral peninsula. The stepped massing to the prow of the building creates landscaped terraces which allow patients to access nature and fresh air. Radiotherapy benefits from a huge central lightwell, and access to an outdoor Winter Garden.
A biobank allows collection of a variety of cancer types, both common and rare, giving scientists the best snapshot of the current cancer landscape. This increases knowledge and understanding which will lead to new and improved treatment options for the future
The pharmacy department is located within a purpose-built facility that houses five isolators and a gene therapy isolator. The core business of the department is the production of sterile chemotherapy products for patients at the Centre, satellite clinics, and private patients. Other services include the organisation and management of clinical trials, such as the self-medication service and a ward pharmacy service.
Last year, a Merseyside man became the first in the UK to receive a new cancer vaccine designed to help his immune system ward off head and neck cancer permanently. The clinical research team at The Clatterbridge Cancer Centre had given the patient an injection of a therapy tailormade to his personal DNA, and designed to help his own immune system ward off cancer permanently.
Paterson Replacement Project, The Christie, Manchester
This 26,500 m2 facility is currently under construction. The Paterson Building, which housed the majority of the Cancer Research UK Manchester Institute (CRUK MI), caught fire in 2017, resulting in significant structural damage, as well as the loss of years of research, and hundreds of thousands of pounds of equipment. Following feasibility assessments, it was announced that repair and refurbishment of the Paterson Building would not be viable, and that the building would be demolished and replaced with a modern facility. CRUK MI temporarily relocated to Alderley Park in Cheshire, one of the largest life science communities in Europe, occupying laboratory and office space in an agreement that will see scientists conduct research and development activity from a site that already has an international reputation for breakthroughs in oncology.
Aspiration for a world-class facility
The aspiration for the Paterson Replacement Project (PRP) is for the delivery of a world-class research facility on The Christie Withington site, which is is the home to The Christie NHS Foundation Trust, the Oglesby Cancer Research Building (formally Manchester Cancer Research Centre (MCRC)), the CRUK Manchester Institute, and the Maggie’s Centre. The breadth of the activity will be expanded, with specific public and patient-focused themes to work on prevention, early identification of cancer, and living with cancer, which will accelerate progress towards realising the ambition to become a ‘Top 5’ translational cancer research centre in the world by 2025
The new building will be part seven and part 10 storeys high (plus basement), and will enable multiple teams engaged in the ‘research pipeline’ that leads from discovery to clinical applications to be co-located into a single facility, and physically linked to a world-leading cancer hospital with ease of access to patients. The Ground Floor Level provides the main entrance and the reception to the research centre. It will also act as a hub for collaboration, via engagement spaces and a publicly accessible cafe, which will promote interactions between scientists, clinicians, and allied medical professionals. This level will showcase the research and development being undertaken by the Christie, and be an open, welcoming, and accessible facility, which encourages public engagement and community outreach.
Integration with other research facilities
Before the fire The Manchester Centre for Biomarker Sciences was to be provided as an extension to the Oglesby Cancer Research Building, but the PRP provided the opportunity to physically integrate this important facility with the hospital, and among other specialist research activities. This will provide a world-leading centre of excellence for biomarker discovery, validation, and clinical qualification, and will deliver a key objective of the Greater Manchester Cancer Plan.
Co-location of the new research building and the adjacent existing hospital will facilitate access for clinicians and researchers to patient wards (particularly the clinical trials unit) and other facilities. This will ensure there is connectivity for clinicians, scientists, and researchers to move quickly from bed to bench-side (i.e. the laboratories). Links to the integrated procedures unit will allow easier access for the collection of tumour samples from patients having biopsies as part of their care. These tissue samples can be quickly preserved and transferred for research use within the PRP laboratories. Delays in collecting and using tissue samples can result in the failure of experiments.
Laboratory accommodation and research spaces
The basement, plus Levels 3, 4, 5 and 6, house the laboratory accommodation and research spaces. To inform the building’s design and layout, the design team has engaged with the users of the laboratories to devise a standardised laboratory module, which will become the ‘building blocks’ for the new building. The standardised module has informed the size and proportion of the other more specialist laboratories in the building.
While such specialist laboratories will require different spaces and functions (due to different scientific criteria), the standardised approach means that the project partners can easily convert the laboratories into standard laboratory modules. Groups of laboratories are to be assembled in rectangular blocks that are regular, repeated, adaptable, and flexible, so they can respond to the various scientific functions that take place within them, and also to the future developments anticipated in scientific cancer research over the lifetime of the building space. To maximise the developable area of the building, the building footprint has been cantilevered both along the length and width of the building.
Dedicated workspace for scientists and researchers
Alongside each laboratory module, there will be a dedicated workspace for the researchers and scientists to write up research results. It is critical for this workspace to be immediately adjacent to the laboratories to ensure that scientists can move seamlessly between their bench and desk, and to promote collaboration with their colleagues.
Oak Cancer Centre, South London
The Royal Marsden is a centre of excellence with an international reputation for ground-breaking research, pioneering the very latest in cancer treatments and technologies, and specialising in cancer diagnosis and education. The Trust has campuses in Sutton, Chelsea, and a Medical Day Care Unit at Kingston Hospital. The Sutton site currently provides world-class cancer care, and acts as the site for two-thirds of the Trust’s clinical research, working in conjunction with the Institute of Cancer Research (ICR). Some of the buildings and infrastructure date from the 1960s, and their researchers are spread out across the site. This is hindering the Trust’s ability to confront some of the most pressing challenges in cancer research and treatment.
The new six-storey Oak Cancer Centre (OCC) will provide a centre for the rapid diagnostics of cancer, increased operational capacity for outpatients and ambulatory day care, and a clinical assessment unit. Research facilities provided will bring researchers under one roof, enabling greater collaboration between their experts in oncology, and accelerating the development of new treatments, including for cancers that are more difficult to treat.
The OCC has been designed to evoke a confident sense of optimism. The glazed ‘shop window’ double height entrance / arrival / waiting space provides a very welcoming active frontage along the western façade, enabling views into the semi-public arrival, reception, and waiting space, while also benefitting these interior spaces with clear views out towards the landscape. The entrance glazing at first floor level merges with the glazed slot forming the external envelope to the research floor.
The geometry of the building concept is very simple, and is characterised by a west-facing crescent / concave curve orientated towards a new garden composed of some existing mature copper beech trees, and augmented with some mature new trees and soft landscape. The crescent at the front of the building presents a welcoming gesture to those approaching. At either end of the crescent there are level access terraces which the patients and staff can break out onto if they need a breath of fresh air, or just a change of scene.
Entrance level
The entrance level co-locates all of the general outpatient clinics, the haematology / oncology outpatients, phlebotomy, and the dispensing pharmacy, on the same level. This means that a high proportion of the daily flow of patients and visitors can easily access the building at this entry level, and will not need to move vertically through the building using stairs or lifts. A significant proportion of patients will be very frail and not very mobile.
Additional stair / lift cores are provided for staff / clinical movement at the southern and northern ends of the building. The southern core leads directly to a link corridor connecting to the RMH, providing level access at ground and first floor level. One of the key flows between the existing estate and new OCC is for staff crossing the link and using the southern stair / lift core to move up the building to the staff café / restaurant at level 3.
The first floor provides space for researchers. This is a ‘dry-lab’ space comprised of open plan workstations, break-out spaces, meeting rooms, and some single to six person cellular offices. The researchers were located intentionally at this level, within the heart of the OCC, to ensure that they had a visible and reassuring presence within the building, reinforcing the strong link between patient care and research. A visual link between the research and clinical floors was an important part of the concept to showcase the work that is being done to help treat and cure the cancers which patients are getting treatment for. The buzzing activity of the cutting-edge research that takes place on this level is showcased both inside and outside. The first floor is also connected directly via the link corridor to the RMH.
Infusion bays
The 63 medical day care chemotherapy infusion bays are located at level 2, giving them a greater degree of privacy, and are orientated along a sweep towards the western side of the site to benefit from the site’s most positive aspect, with an outlook onto gardens formed of existing and new trees. The crescent of space projects out beyond the accommodation below, so that the patients almost feel like they are within the canopy of the trees. The bays are arranged in groups of three, to correspond with the nursing ratio of one clinician to three patients.
It has been clear throughout the design process that the theme of personalisation of clinical treatment and care, and also being able to control environments, have been key to the success of these building types. Strong visual connections to nature, and controlled access to external spaces at the Clatterbridge and the Oak Cancer Centres, provide healthy respite and wellbeing while receiving treatment.
Proximity and connectivity
Co-location of specialist hospitals, scientific research, and academic centres on the same site are clearly hugely advantageous, and allow improved connectivity. Proximity and connectivity are critical to the Team Science method of working. Medics are working collaboratively with researchers to develop new thinking. While it might be a current buzzword, clinical trials and drug discovery couldn’t run without collaboration, and we are being challenged as designers to create spaces and places that facilitate that
Chris Oates
Chris Oates, Architect director at BDP, joined the practice in 2014, and became the Design Team leader for the Clatterbridge Cancer Centre in 2015, and the Paterson Replacement Project at the Christie hospital in 2018. Prior to joining BDP he had worked on a range of sectors and scale of projects, but he finds the people-focused nature and complexity of healthcare projects the most rewarding. Through these large complex projects, involving multiple stakeholders, he has facilitated collaboration and engagement between all project team members at all stages of the project, reinforcing his belief that this is key to the successful delivery of projects. He embraces the future challenges of having to deliver unique and innovative design solutions for clients, while offering flexibility in use. All this needs to be underpinned by efficient design solutions which are key to meeting sustainable design, BIM, & MMC criteria, and Net Zero carbon targets.